Testing Errors Rampant at Family Medical Clinics

Researchers working on a study of testing errors reported by family physician offices in the United States found that problems exist throughout the entire testing process.Â Worse, these errors impact minority patients more than nonminority patients.Â The report appears in the June 2008 issue of Quality & Safety in Health Care.Â This study is considered the largest of its kind, to date.

The researchers report that medical testing errors led to lost time, lost money, delays in care, and pain and suffering for patients, with adverse consequences affecting minority patients far more often than nonminority patients.Â “I think everybody has had an occasion where their physician did a test, and they just didn’t hear back,” said John Hickner, MD, professor and vice chair of family medicine at the University of Chicago Medical Center. “People identify that as a common experience.Â The incident reports we received voluntarily from family physicians and their office staff detail what the problem areas are.”Â Hickner added, “There’s a fair amount of risk and harm that results from testing mistakes and slips.Â This data provides a starting point for improvement.”

The study was conducted at eight family physician offices, which were part of the American Academy of Family Physicians National Research Network, with four located in rural areas, three in urban areas, and one in a suburban location.Â The study was conducted during 32 weeks in 2004; 243 clinicians and office staff submitted 590 anonymous reports that described 966 medical-test-related errors. Tests conducted included lab work, diagnostic imaging, and tests such as pulmonary function tests and electrocardiograms.

Testing errors were classified in 10 groups:Â Test ordering, test implementation, reporting results to the clinician, clinician responding to results, notifying the patient of results, administrative, treatments, communications, other process errors, and knowledge and skills.Â The most common errors involved failure to report results to the clinician, accounting for about 25 percent of all reported mistakes.Â Test implementation and administrative errors represented the next most common errors, at slightly more than 17 percent each.Â Also, test implementation errors were nearly double for minority groups:Â 32 percent versus 18 percent for non-Hispanic whites.Â The investigators felt these particular errors could have been the result of transportation problems or lack of insurance.Â Another quarter of the errors caused delays in patient care; 18 percent resulted in harm; and 13 percent caused pain, suffering, or a definite adverse clinical consequence.Â “One of the most striking and disturbing findings was that minority patients were nearly three times more likely to experience adverse consequences,” Hickner said, and twice as likely to experience physical harm from errors.

The researchers reported considerable variations in the errors reported from each practice. “While significant physical harm was rare, adverse consequences for patients were common,” Hickner said. “This study strongly supports the need for office-by-office improvements in the overall testing process within primary care.”Â Although not designed to determine the true error rate, “testing-process errors appear to be common,” the authors conclude. “Since many errors are undetected or unreported, we can assume this is an extreme lower bound.”